Call Centers Got Big Deals Under Health Law, But How Big?

Before the Affordable Care Act was even open for enrollment, Viviana Alvarado was already taking calls from people who wanted to know more.

She and about 40 of her colleagues are staffing the phones for Maximus, the company Connecticut has contracted to run its call center.

The government contractors running the troubled HealthCare.gov website have been under intense scrutiny in the past month, but those businesses aren't the only ones being paid to rollout Obamacare.

In the states that are running their own health care exchanges, practices vary. Oregon, for instance, set up its own call centers; other states, like Connecticut, farm that business out to companies like Maximus.

"It's a huge opportunity, and it remains so," says Rick Howard, an analyst at Gartner, a technology research firm. "There are millions of millions of folks coming in for insurance coverage. That represents a great opportunity for both commercial carriers and for those contractors who are servicing health care."

How much is Maximus making in Connecticut? In a press release, the company valued the contract at $15 million over three years, for staffing and operating the call center. But that lump sum is all the information the company provides.

Access Health CT, the state's exchange, wouldn't confirm the $15 million price tag. And while it will say that it is paying a per minute fee per call, it won't say how that fee is calculated. In fact, its contract with Maximus that it makes available to the public blacks out all language that has to do with pricing.

That means that taxpayers can't know how much the state of Connecticut is paying Maximus.

Why?

Well, redactions are things that typically relate to privacy and competitive issues from vendors," says Kevin Counihan, CEO of Access Health CT, the state's new insurance marketplace. Counihan says state law allows vendors like Maximus to redact what they think is proprietary information from public documents.

But should pricing be propriety in a government contract?

"Is price something that someone should be able to redact? I sure think so. What's the whole point? If everybody knows what everybody is pricing, everybody's going to be pricing at the same level. And that doesn't drive a good deal," Counihan says.

Maximus refused to comment on its Connecticut pricing. In a statement, the company says call centers are in a "highly competitive industry."

But in emails to the state, the company justifies its position by saying that releasing its pricing information would "result in irreparable economic damage to Maximus and significantly weaken its competitive position in the marketplace."

Maximus also has a contract in Hawaii. But in that state it doesn't have to disclose its contracts at all because its entire health insurance marketplace, the Hawaii Health Connector, is exempt from the state's sunshine laws.

Vermont's exchange handled things differently. It has posted on the internet a complete, unredacted copy of its contract with Maximus. The document spells out everything from how long a call can be on hold to how quickly it must be answered.

Mark Larson, the head of Vermont's exchange, explains: "We are spending taxpayer dollars and we understand our responsibility to ensure that there's transparency in how those dollars are being spent, to whom they're being given, and what we get in return for them. And we want to make sure that it's easy for Vermonters or others to find that information."

According to the contract, Vermont pays Maximus 86 cents a minute for calls, and the state estimates a call volume of about 573,300 minutes per month. That comes out to about $500,000 a month.

Rick Howard, the Gartner analyst, says that, in an ideal world, none of the call center prices would matter. Everyone would sign up on the Internet.

"This is just a really complicated, initially, enrollment cycle," Howard says. "Once the websites continue to evolve, then I would expect, over time, call center activities to be greatly reduced from what they were here in the first months or year of the marketplace."

Until that happens, there's money to be made. But in Connecticut, the public just can't know how much.

This story is part of a collaboration with NPR, WNPR and Kaiser Health News.

Government contractors here in the U.S. have been at the center of the often painful rollout of the Affordable Care Act. Most notably they're getting a lot of the blame for the error-prone website Healthcare.gov.

New healthcare call centers in many states are also managed by contractors. As Jeff Cohen of member station WNPR reports, it's a lucrative business.

VIVIANA ALVARADO: The different plans, each plan provides you with different things...

JEFF COHEN, BYLINE: Before the Affordable Care Act was even open for enrollment, Viviana Alvarado was already taking calls from people who wanted to know more.

ALVARADO: OK, the platinum would be the plan paying 90 percent of your services, and then you would only have to pay 10 percent, and it goes down. The gold is 80 percent and then you...

COHEN: Alvarado, and about 70 others are the consumer end of a very big businesses under Obamacare - call centers. They work for Maximus, the company Connecticut has contracted for the job.

In the states that are running their own health care exchanges, practices vary. Oregon, for instance, is setting up its own call centers; others, like Connecticut, farm that business out to companies like Maximus.

RICK HOWARD: It's a huge opportunity and it remains so.

COHEN: Rick Howard works as an analyst at Gartner, a technology research firm. He says this is big business.

HOWARD: The bottom line is they're millions of millions of folks coming in for insurance coverage. That represents great opportunity for both commercial carriers and for those contractors who are servicing health care.

COHEN: And how much is Maximus making in Connecticut? In a press release, the company valued the contract at $15 million over three years, for staffing and operating the call center. But that lump sum is all the information you can get.

Access Health CT, the state's exchange, wouldn't confirm the $15 million price tag. And while it will say that it is paying a per minute fee per call, it won't say how that fee is calculated. In fact, its publicly available contract with Maximus blacks out all language that has anything to do with pricing.

Which is to say that, you, the taxpayer, can't know how much the state of Connecticut is paying Maximus.

The question is, why?

KEVIN COUNIHAN: Well, redactions are things that typically relate to privacy and competitive issues from vendors.

COHEN: That's Kevin Counihan. He runs Access Health CT. He says state law allows vendors like Maximus to redact what they think is proprietary information from public documents.

But should pricing be propriety?

COUNIHAN: Is price something that someone should be able to redact? I sure think so. What's the whole point? If everybody knows what everybody is pricing, everyone's going to be pricing at the same level. And that doesn't drive a good deal.

COHEN: Maximus refused to comment on its Connecticut pricing. In a statement, the company says call centers are in a quote, "highly-competitive industry."

But in emails to the state, the company justifies its position by saying that releasing its pricing information would, quote, "result in irreparable economic damage to Maximus and significantly weaken its competitive position in the marketplace."

Maximus also has a contract in Hawaii. But that state says it doesn't have to disclose its contracts because its entire health insurance marketplace, the Hawaii Health Connector, is exempt from the state's sunshine laws.

Vermont's exchange handled things differently - it has posted on the Internet a complete, un-redacted copy of its contract with Maximus. And it spells out everything from how long a call can be on hold to how quickly it must be answered.

Mark Larson is the head of Vermont's exchange.

MARK LARSON: We are spending taxpayer dollars and we understand our responsibility to ensure that there's transparency in how those dollars are being spent, to whom they're being given, and what we get in return for them. And we want to make sure that it's easy for Vermonters or others to find that information.

COHEN: Vermont's contract with Maximus also talks about pricing. The state pays 86 cents a minute for calls and it estimates about 573,000 minutes per month. That comes out to about a half a million dollars a month.

Rick Howard, the Gartner analyst, says that, in an ideal world, none of this would matter. Everyone would sign up online.

HOWARD: This is just a really complicated, initially, enrollment cycle. Once the websites continue to evolve, then I would expect, over time, call center activities to be greatly reduced from what they were here in the first months or year of the marketplace operations.

COHEN: Until that happens, there's money to be made. But in Connecticut, you just can't know how much.

For NPR News, I'm Jeff Cohen in Hartford.

(SOUNDBITE OF MUSIC)

MONTAGNE: That story is part of a reporting partnership with NPR, WNPR and Kaiser Health News. This is MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.